reproductive health

 Most of us grow up expecting to one day meet the man or woman of our dreams, get married, and create a loving family together by having children.  Unfortunately, for some of us, this dream is not easily attained.  Experiencing disappointment and heartbreak month after month can have devastating effects on a couple and all aspects of their lives.  Coping with the losses and uncertainties that infertility brings can create great emotional turmoil. If you find yourself feeling depressed, anxious, preoccupied with your infertility, unable to make treatment decisions, isolated from your friends and family, or trying to repair a strained marriage, you are not alone. 

Psychological counseling can provide you and your spouse with the skills you need to face the emotional challenges of infertility, improve your marital relationship, develop your decision-making skills related to treatment, and regain your happy, productive lives.  Common issues addressed in infertility counseling include:

• Depression and anxiety
• Feelings of grief and loss
• Stress management and relaxation training
• Decision-making related to treatment
• Exploration of family building options
• Consideration of third party reproduction
• Deciding if and when to end fertility treatments
• Improving communication with spouse
• More effective ways for spouses to support one another
• Reducing marital conflict and increasing intimacy
• Sexual difficulties related to infertility treatment
• Relationships with family, friends and co-workers
• Social isolation
• Coping with hurtful comments and questions
• Deciding if, how, and when to tell others about your infertility and family building decisions
• Coping with holidays, family gatherings and child-focused social activities

 Losing a baby through miscarriage, stillbirth or early infant death can be completely devastating.  You may feel that you will never be quite the same again, that this loss has changed you forever.  You may be feeling intense sadness, anger, confusion, guilt, shame, fear and/or numbness.  Pregnancy loss often feels intangible and unreal because you may never have had a chance to see or hold your baby.  You don’t know how to mourn.  You have no memories to hold onto, only the hopes and dreams you had for your baby, now gone.

Loved ones often feel uncomfortable around grief, so they try to encourage those grieving to get on with their lives.  Well-meaning family and friends may say things to try to help you feel better, such as, "You will have more children", "At least it was early in the pregnancy", or "Be glad you already have children."  Despite their good intentions, these comments can be upsetting and injurious to a grieving parent.  Many bereaved parents feel isolated from others because they don't seem to understand what you're going through and they want you to accept the death and move on. 

Grieving the death of a baby may last far longer than you and others expect.  Be patient with yourself and do not expect too much too soon. Respect your needs and limitations as you work through your grief and begin to heal.  Until you have been able to fully process your emotions and come to some sense of closure, you will not be able to move on with your life in a healthy and productive way.

Grief counseling can provide you with a safe and nurturing environment in which to fully grieve your loss.  Working through grief involves processing your feelings, uncovering the personal significance of what has been lost, finding ways to honor your baby's memory, and learning to accept the finality of your baby’s death.  Men and women grieve in different ways, frequently misunderstanding each other’s reactions or needs.  Women are often more outwardly expressive of their pain and are disappointed by their partner’s lack of emotional expression.  Likewise, men are sometimes overwhelmed by their partner’s intensity of emotion and feel incapable of comforting her.  Couples counseling can aid you in facing the emotional challenges of your loss together, help you develop new coping skills to deal with this life crisis, and teach you how to support one another in more effective ways.

 You’ve just had a baby, one of the most important and joyous events in your life.  You expected to feel happy, even elated.  So why are you so miserable?  Up to 80% of new mothers experience mood disturbances after giving birth.  They feel tired, tearful, anxious, and overwhelmed with their new responsibilities.  For most women, the symptoms are mild and go away on their own after a few days.  Symptoms are not severe and treatment isn’t needed.  This is referred to as the “baby blues.”  However, 10 – 20% of new mothers develop a more severe form of a mood disorder called Postpartum Depression and/or Anxiety.  

Postpartum depression can develop anytime within the first year after childbirth. A woman may have a number of symptoms such as sadness, lack of energy, trouble concentrating, anxiety, and feelings of guilt and worthlessness. The difference between postpartum depression and the baby blues is that postpartum depression affects a woman’s total well-being and interferes with her ability to function for a significant period of time. Postpartum depression is a serious disorder and needs to be treated by experienced health care professionals. Unfortunately, many suffering new mothers go untreated because they don’t realize their symptoms are treatable, don’t recognize the severity of their suffering, and/or are ashamed to admit their feelings to their loved ones or healthcare providers.

It is important to realize that you are not alone, you are not to blame, and you can feel better again.

Who is at risk for developing Postpartum Depression and Anxiety?

Anyone can develop postpartum depression and anxiety.  However, new mothers with the following experiences have an increased risk for developing this disorder:

• Previous history of postpartum depression
• Difficult or traumatic birth process
• Premature or ailing newborn
• First-time pregnancy
• Significant life stressors (such as financial troubles, marital problems or family conflicts)
• Abrupt weaning
• Depression or anxiety during pregnancy
• Personal or family history of depression or anxiety
• History of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) 
• Social isolation
• Poor support from partner, family, or friends
• History of mood changes while taking birth control pills or fertility medication
• History of thyroid dysfunction

What are the symptoms of Postpartum Depression and Anxiety?

It is normal to experience ups and downs following the birth of your baby.  However, if you experience any of these symptoms for a prolonged period of time, you could be suffering from postpartum depression or anxiety:

• Persistent feelings of sadness and hopelessness
• Frequent bouts of crying or tearfulness
• Mood swings
• Feeling overwhelmed
• Decreased energy, fatigue, or exhaustion
• Doubting your ability to properly care for your baby
• Feeling like a failure
• Overconcern for your baby or lack of interest in the baby
• Fear of harming your baby or yourself
• Feelings of guilt, worthlessness and helplessness
• Feelings of restlessness, tension and irritability
• Feeling numb or “empty”
• High levels of anxiety and worry
• Fear of losing control or going “crazy”
• Change in your sleep patterns (difficulty falling asleep and/or staying asleep or sleeping more than usual)
• Change in your appetite or weight (increase or decrease)
• Difficulty concentrating, remembering, and/or making decisions
• Diminished ability to accomplish tasks
• Loss of interest or pleasure in activities that were once enjoyed (including sexual activity)
• Withdrawal from family and/or friends

What effects can untreated postpartum depression have on me or my baby?

Postpartum depression can significantly affect your ability to care for your baby. You may feel fatigued, have trouble concentrating, be irritable, and not be able to meet your child’s needs.  As a result, you may feel guilty and lose confidence in yourself as a mother, which can worsen the depression. Researchers have found that postpartum depression can affect children by causing sleep disturbances, problems with emotional bonding, delays in language development, and behavioral difficulties. 

How can psychological treatment help me cope with postpartum depression?

All mothers deserve the chance to enjoy their life and their children.  You don’t have to suffer anymore.  Psychotherapy can help you get back to your old self once again. It can provide you with an understanding and nonjudgmental environment in which to explore the variety of issues contributing to your depression and/or anxiety.  Motherhood is difficult and requires a complex set of decision-making, problem-solving, and coping skills to navigate the day-to-day struggles.  Psychotherapy can help you develop your repertoire of coping strategies and assist you in redefining your new role as a mother.  We often set unrealistically high expectations for ourselves, setting ourselves up for failure.  In therapy, you can reevaluate your expectations, learn to set more realistic goals for yourself and your family, and learn how to access and accept support in your life and community. 

Menopause represents a time of transition in a woman’s life. Women undergo both physical and emotional challenges during this period.  As women approach midlife, they often find themselves experiencing changes in self-esteem, body image, and self-concept, especially when confronted with our youth-oriented society.    While our bodies are changing, we also find that our roles and relationships are changing too.  During midlife, women are confronted with many new demands and challenges including:

• Parenting adolescent children
• Return of grown children to home
• Empty nesting
• Redefining role with spouse/partner
• Divorce/remarriage
• Changes in sexuality
• Loss of loved ones
• Finding new purpose and meaning in your life
• Concerns about aging parents
• Elder care-giving issues
• Career changes
• Financial difficulties
• Reevaluation of future goals
• Confronting the mortality of yourself or others

While these issues can cause women at mid-life to feel overwhelmed, depressed, out-of-control, angry, or empty, this transitional time can also be viewed as an opportunity for positive transformation and growth.  Psychotherapy can provide you with a safe and confidential forum to explore the many changes in your life, develop coping skills to meet life’s new challenges, support you in making positive life decisions, and help you in creating a renewed sense of self-confidence, balance, and happiness.